Mental Imagery

 

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Process of Mental Imagery

There are two models that are used most frequently in the literature for the process of mental imagery. In the first model, the applied model, athletes use imagery to accomplish cognitive, effective, and behavioral outcomes. It includes three factors: the sport situation, types of imagery, and imagery ability to contribute to its effectiveness. In other words, what you imagine is what the intended outcome is. There are several types of imagery within this model such as: cognitive specific, cognitive general, motivational specific, motivational general arousal, motivational general master, and many more [1].

The second model, the PETTLEP, is based off the notion that brain structures are activated during imagery. It is this neural component that modulates motor and sports performance. PETTLEP stands for physical, environment, task, timing, learning, emotion, and perspective. The imagery used should incorporate each factor stated previously and be as realistic as possible. For example, the athlete should imagine himself/herself in their uniform, on their home field/court, going through the motions of the game at game speed [1].

The actual process to how mental imagery is performed is not well researched. In most of the literature the process is not even mentioned. There are many questions that need to be answered such as: Do you perform MI in a dark room? Does someone need to read a script to the athlete? How long should the athlete perform MI? How many times a week? Treatment protocols used by physical therapists are uncommon and highly variable[2]. At this point, protocols are suggested and need further research to support them. MI has been used in other realms of physical therapy such as in motor learning and motor rehabilitation for many years and is supported more in the neurorehabilitation literature.

Liu and colleagues (2004) examined a protocol for improvement of ADL's and upper-extremity use after stroke. The imagery group performed 3 practice sets, of 5 ADL tasks, given for 1 hour, 5 days a week for 3 weeks. The first week was the easiest ADL tasks and the last week was the most difficult consisting of going shopping or to a park. The imagery group achieved a significantly higher performance level on the trained tasks as well as untrained tasks compared to the control group. Page and colleagues provided their patients with 30 minutes of imagery twice a week using an audio tape. At the end of 6 weeks the patients demonstrated improvements in the tasks discussed on the tape[3].

An article by Dickstein, Dunsky, and Marcovitz (2004) stated that MI should be performed with subjects in a reclined position and eyes closed. Exercises to relax the subject’s body should be performed first then they should precede with MI. A meta-analysis stated that healthy individuals shouldn’t use MI for any longer than 20 minutes due to a negative effect with increased practice duration. For patients who have had a stroke, one researcher recommended that training times should be between 12-15 minutes [4].

Continued research needs to be performed to provide a better understanding of the requirements for MI and what produces the best results. At this point there is a consensus that MI improves the ability to perform practiced tasks but there is no guideline as to the exact process. 

Influences on Performance

Mental imagery can be an important aspect in increasing the performance of athletes in their perspective sports. Mental imagery is described as “repetitive mental practice or mental training that designates mental representation of the performance of a motor pattern without concomitant production on the muscular activity normally required for the act.”[5] Mental imagery is a technique that athletes can use to supplement physical practice and improve their performance in their given sport. Mental imagery is often part of a mental practice routine that might also include such techniques as relaxation, self-talk, and goal setting. Athletes use mental imagery in these programs so much that mental imagery and mental practice have almost become synonymous terms.[1] Research has proven that mental imagery is effective in increasing performance in such sports as:

  • dart throwing
  • diving
  • figure skating
  • gymnastics

These studies can also be generalized to other sporting performances.[6] Healthy individuals using mental imagery may experience performance gains in areas such as:

  • strength
  • arm-pointing capacity
  • range of motion
  • postural control
  • speed
  • accuracy
  • motor skills.[2]

There are several considerations to take into account when using a mental imagery program to improve performance for athletes. Mental imagery seems to be better than no practice at all, but mental imagery alone is not as good as physical practice alone. Mental imagery cannot completely substitute for physical practice and it appears as though a combination of mental imagery and physical practice leads to the most effective performance.[6] There also appears to be a difference in the effectiveness of mental imagery between novice and elite athletes. Novice athletes use mental imagery less effectively than elite athletes do because elite athletes “use mental imagery more frequently, have better visualization abilities, and employ more structured mental practice sessions.”[6]

Mental imagery is most effective when practiced over time; however, research has shown that athletes most often use mental imagery immediately prior to an event to help boost performance. Laboratory studies show that using mental imagery without prior practice is still effective as long as the performance comes directly after the mental imagery use.[1] For example, a golfer may experience good results using mental imagery techniques immediately prior to hitting their golf shot while mental imagery used once a week before the tournament may not provide much benefit. Mental imagery is a technique that can help athletes improve their performance but just like all other skills it requires practice to be most effective.

Influences on Rehabilitation & Recovery

In addition to influencing performance, mental imagery has been used in conjunction with rehabilitation and recovery. Mental imagery as an adjunct to physical medicine during rehabilitation may be used in several ways to:

  • Help patient cope with pain
  • Speed the healing recovery process
  • Prevent the deterioration of physical skills due to injury and immobility[7] 
  • Increase adherence to a rehabilitation program[8]

Mental imagery is thought to have both physiological and psychological benefit to the injured person. While the mechanisms behind this mind body connection are not fully understood, according to Jones & Stuth[8], “It is widely accepted within the medical profession that the mind and body are an integrated system and that the mind plays a significant role in both the etiology of disease and recovery.” Mental imagery has been reported to trigger neurophysiological changes, improve immune response and have an effect on the autonomic nervous system[7][9].

The types of imagery used in rehabilitation may include:

  • Images of the injury being healed and mended
  • Images of complete recovery
  • Images of performing sports or activity without injury

Controlled Studies on Mental Imagery and Rehabilitation

Cressman and Dawson (2011)[10] examined the effect of healing imagery on 9 collegiate athletes. The study compared the two experimental groups along 3 dimensions: satisfaction with rehabilitation, self-efficacy to recover, and return to play. There were no significant differences between groups with respect to self-efficacy or return to play, however, the intervention group had a significant positive effect with respect to satisfaction with rehabilitation.

Guillot et al (2009)[11] found that mental imagery may help facilitate motor recovery for burn patients.

Christakou, Zervas & Lavalle (2007)[12] investigated the adjunctive role of imagery to functional rehabilitation for athletes with grade II ankle sprains in terms of improvements in muscular endurance, dynamic balance and functional stability. Mental imagery demonstrated a significant difference on muscular endurance but not dynamic balance or stability.

Several controlled studies have examined the effect of mental imagery on ACL reconstruction and rehabilitation:

  • Cupal & Brewer (2001)[13] found significantly greater knee strength and significantly less re-injury anxiety and pain for the intervention group who received guided relaxation and imagery session in addition to physical rehabilitation.
  • Conversely, Maddison et al. (2011)[14] found no significant effect on knee strength or self-efficacy with guided imagery intervention, but did find a significant positive effect on knee laxity and healing related neurobiological factors that decreased the participants stress response.
  • Lebon, Guillot & Collet (2011)[15] found that motor imagery enhanced muscle activation for ACL rehab patients. They hypothesized that the effect may stem from a redistribution of central neuronal activity since there was a lack of anthropometric changes in the intervention subjects. These authors recommend that imagery should be done early in the rehabilitation process when passive and active muscle activity is most limited by injury.

Influences on Relaxation and Stress Management

The psychological aspect of sports and competition is often overlooked. Many studies show that mental imagery helps reduce athletes’ stress and anxiety and increase relaxation. Mousavi and Meshkini (2011)[16] found that among elite tennis players with similar physical ability, the group who used mental imagery during sport had a mean reduction of 21.5 for their scores on the Ketle 40-item anxiety questionnaire compared to the group who did not use mental imagery which had a mean score reduction of 1.2. Additionally, Naylor (2009)[17] suggests that supplementing diaphragmatic breathing training with mental imagery further enhances relaxation and reduces sports-related stress and anxiety.

In addition to general sports-related stress, athletes often experience psychological distress and depressed emotions after injury and into the early rehabilitative phase[18]. Although athletes experience these emotions, physical therapy rarely addresses the psychological aspects of returning to sport[19]. Evans, Hare, and Mullen (2006)[20] found imagery to be useful for athletes throughout all phases of rehabilitation to help reduce their fear of re-injuring themselves and decrease stress and anxiety of returning to sport.

Studies have repeatedly found that mental imagery is effective in reducing stress and anxiety for competition; however it is unclear how individuals use the imagery because it has many different forms and situations it can be used in. Bernier and Fournier (2010)[21] studied the effects of mental imagery on expert golfers and found that the golfers focused on different images depending on the environment, shot, psychological state, competition, and many other variables. They found that the majority of golfers using mental imagery to help manage stress and arousal used images of outcome, which include seeing the ball in the hole, winning a tournament, or visualizing a good ball roll[21]. As far as when to use mental imagery, to relieve stress and anxiety, athletes most frequently use imagery before a competitive event, rather than during or after[22].

Not only does research show that mental imagery can help relaxation and stress reduction in athletes, but it has also been shown to reduce stress and anxiety in pregnant women as compared to a control group. Increased stress in pregnant women has been linked to negative outcomes such as increased number of preterm births, low infant birth weight, and developmental delays in children[23]. In addition to decreased anxiety and stress, they found that the group of pregnant women performing mental imaging had significantly less fatigue than the group who had no mental imaging training[23]. In addition to helping reduce stress in pregnant women, Cancio (1991)[24] found that mental imagery reduced stress levels in 81% of an Army Airborne division while they were performing free-fall parachute jumps.

References

  1. 1.0 1.1 1.2 1.3 Weinberg, R. Does imagery work? Effects on performance and mental skills. Journal of Imagery Research in Sport and Physical Activity 2008;3:1-23.
  2. 2.0 2.1 Dickstein, R., Deutsch, J. Motor imagery in physical therapist practice. PHYS THER 2007; 87: 942-953.
  3. Liu, K., Chan, C., Lee, T., Hui-Chan, C. Mental imagery for promoting relearning for people after stroke: A randomized controlled trial. Arch Phys Med Rehabil 2004;85:1403–1408.
  4. Dickstein, R., Dunsky, A., Marcovitz, E. Motor imagery for gait rehabilitation in poststroke hemiparesis. Phys Ther 2004;84: 1167–1177.
  5. Deschaumes-Molinaro C, Dittmar A, Vernet-Maury E. Relationship between mental imagery and sporting performance. Behavioral Brain Research. 1991;45:29-36.
  6. 6.0 6.1 6.2 Cocks M, Moulton C, Luu S, Cil T. What surgeons can learn from athletes: Mental practice in sports and surgery. Journal of Surgical Education. 2014;71(2):262-269.
  7. 7.0 7.1 Richardson P, Latuda L. Therapeutic imagery and athletic injuries. Journal of Athletic Training. 1995; 30(1):10-12.
  8. 8.0 8.1 Jones L, Stuth G. The uses of mental imagery in athletics: An overview. Applied and Preventive Psychology. 1997;6(2):101-115.
  9. Newmark T, Bogacki D. The Use of Relaxation, Hypnosis, and Imagery in Sport Psychiatry. Clinics in Sports Medicine. 2005;24(4):973-977.
  10. Cressman J, Dawson K. Evaluation of the Use of Healing Imagery in Athletic Injury Rehabilitation. Journal of Imagery Research in Sport and Physical Activity. 2011;6(1).
  11. Guillot A, Lebon F, Vernay M, Girbon J, Doyon J, Collet C. Effect of Motor Imagery in the Rehabilitation of Burn Patients. Journal of Burn Care & Research. 2009;30(4):686-693.
  12. Christakou A, Zervas Y, Lavallee D. The adjunctive role of imagery on the functional rehabilitation of a grade II ankle sprain. Human Movement Science. 2007;26(1):141-154.
  13. Cupal D, Brewer B. Effects of relaxation and guided imagery on knee strength, reinjury anxiety, and pain following anterior cruciate ligament reconstruction. Rehabilitation Psychology. 2001;46(1):28-43.
  14. Maddison R, Prapavessis H, Clatworthy M, Hall C, Foley L, Harper T et al. Guided imagery to improve functional outcomes post-anterior cruciate ligament repair: randomized-controlled pilot trial. Scandinavian Journal of Medicine & Science in Sports. 2011;22(6):816-821.
  15. Lebon F, Guillot A, Collet C. Increased Muscle Activation Following Motor Imagery During the Rehabilitation of the Anterior Cruciate Ligament. Applied Psychophysiology and Biofeedback. 2011;37(1):45-51.
  16. Mousavi SH, Meshkini A. The effect of mental imagery upon the reduction of athletes’ anxiety during sport performance. International Journal of Academic Research in Business and Social Sciences 2011;1:342-5.
  17. Naylor AH. The role of mental training in injury prevention. Athletic Therapy Today 2009;14:27-9.
  18. Tracey J. The emotional response to the injury and rehabilitation process. Journal of Applied Sport Psychology 2003;15:279-93.
  19. Ahern D, Lohr B. Psychosocial factors in sports injury rehabilitation. Clin in Sports Med 2003;16:755-68.
  20. Evans L, Hare R, Mullen R. Imagery use during rehabilitation from injury. Journal of Imagery Research in Sport and Physical Activity 2006; 1:1-19.
  21. 21.0 21.1 Bernier M, Fournier JF. Functions of mental imagery in expert golfers. Psychology of sport and exercise 2010;11:444-52.
  22. Driediger M, Hall C, Callow N. Imagery use by injured athletes: a qualitative analysis. Journal of Sports Sciences 2006;24:261-71.
  23. 23.0 23.1 Jallo N, Ruiz RJ, Elswick RK, French E. Guided imagery for stress and symptom management in pregnant African American women. Evidence-Based Complementary and Alternative Medicine 2014;2014:1-13.
  24. Cancio LC. Stress and trance in free fall parachuting: a pilot study. American Journal of Clinical Hypnosis 1991;33:225-34.